Patil Mukul, Puri Lalit, Gonzalez Chris M
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Urology. 2008 Feb;71(2):173-7. doi: 10.1016/j.urology.2007.09.024.
Electronic medical records (EMRs) have been proposed as technology through which the quality of healthcare could be improved. We present an analysis of the cost and productivity implications associated with the transition from transcription to an EMR system in an ambulatory setting.
Data were collected from eight consecutive fiscal years from 1998 to 2005. Transcription was used in the first 4-year period, and EMR was implemented and used in the later 4-year period. Productivity was defined as ambulatory revenue and the number of patient encounters. All costs related to transcription and EMR implementation were calculated. All data were adjusted for inflation.
Within the transcription era, the transcription costs were $395,404, total revenue was $18,137,945, and patient encounters numbered 52,027. The average transcription cost per encounter was $7.60, average revenue per encounter was $348.63, and average revenue per provider was $505,615. Within the EMR era, the EMR-related costs were $293,406, total revenue was $30,370,647 and patient encounters numbered 65,102. The average documentation cost per encounter was $4.51, average revenue per encounter was $466.51, and average revenue per provider was $690,242. The startup costs of initial EMR implementation were $10,329 per physician provider.
The results of our study have shown that the implementation of an EMR system when an economy of scale exists coincides with an increase in the revenue per encounter and per provider compared with transcription. The advantage of the fixed costs of an EMR system compared with the variable costs of a transcription-based system is the allowance of cash savings in an ambulatory surgical subspecialty practice.
电子病历（EMR）已被视为一种可提升医疗保健质量的技术。我们对门诊环境下从转录病历向电子病历系统转变所涉及的成本及生产力影响进行了分析。
收集了1998年至2005年连续八个财政年度的数据。前四年使用转录病历，后四年实施并使用电子病历。生产力定义为门诊收入及患者诊疗次数。计算了与转录病历和实施电子病历相关的所有成本。所有数据均进行了通胀调整。
在转录病历时代，转录成本为395,404美元，总收入为18,137,945美元，患者诊疗次数为52,027次。每次诊疗的平均转录成本为7.60美元，每次诊疗的平均收入为348.63美元，每位医疗服务提供者的平均收入为505,615美元。在电子病历时代，与电子病历相关的成本为293,406美元，总收入为30,370,647美元，患者诊疗次数为65,102次。每次诊疗的平均记录成本为4.51美元，每次诊疗的平均收入为466.51美元，每位医疗服务提供者的平均收入为690,242美元。每位医生实施初始电子病历系统的启动成本为10,329美元。
我们的研究结果表明，在存在规模经济的情况下实施电子病历系统，与转录病历相比，每次诊疗及每位医疗服务提供者的收入有所增加。与基于转录的系统的可变成本相比，电子病历系统固定成本的优势在于可在门诊手术亚专科实践中节省现金。
